Does ADHD Cause Fatigue?
Yes, individuals with ADHD frequently experience fatigue [1]. Fatigue in ADHD is one of the most common symptoms, yet it is often overlooked due to hyperactive stereotypes [2]. Fatigue in ADHD can be attributed to several factors related to the condition:
- Hyperactivity, a constant state of movement and restlessness is a key characteristic of ADHD that can lead to fatigue [2]. The effort expended trying to focus, another challenge for individuals with ADHD, can also increase fatigue in ADHD [3].
- Sleep issues are another significant factor. It's estimated that 25-50% of children and adolescents with ADHD experience sleep problems, which can lead to prolonged tiredness upon waking and daytime sleepiness [4]. About 25-55% of children with ADHD have sleep disturbances, and 43% of adults with ADHD have trouble sleeping [5]. Sleep problems can be further exacerbated by stimulant medication used to treat ADHD.
- Anxiety, which is often present in individuals with ADHD, can also cause fatigue. The constant worry and stress can be mentally and physically draining [2].
- Medications used to treat ADHD can also contribute to feelings of tiredness. For instance, fatigue affected approximately 2-4% of people who took Adderall in clinical trials [6].
- Overworking and work exhaustion is another potential cause of fatigue in individuals with ADHD. Hyperactivity and medication can increase the ability to focus and work, making individuals more likely to overwork, leading to burnout and exhaustion [2].
Symptoms of Fatigue in ADHD
Fatigue in ADHD can manifest in various ways. The most common symptom is a persistent feeling of tiredness or exhaustion. Tiredness and exhaustion are straightforward symptoms that most individuals recognize and keep
Another symptom of fatigue are sleep problems. Being very tired when going to bed can increase sleep latency (the time it takes to fall asleep) and disrupt sleep structure, making individuals insufficiently rested in the morning [1]. This will perpetuate the perceived fatigue in ADHD [5, 7].
Brain fog can also signify fatigue in ADHD. Brain fog can feel like mind wandering, forgetfulness, sleepiness, loss of motivation, slow physical movement or inability to find words to express your thoughts [8].
Treatment of Fatigue in ADHD
The treatment of fatigue in ADHD often involves the use of psychostimulant medications.
Methylphenidate is the first-line treatment for ADHD approved in most countries. Methylphenidate is a stimulant medication that addresses fatigue in ADHD by increasing levels of dopamine and serotonin, regulating mood and alertness [9]. Methylphenidate has also been trialled in the treatment of chronic fatigue syndrome, suggesting this ADHD stimulant is particularly effective at reducing fatigue [10].
Another medication option is atomoxetine, which is a selective norepinephrine reuptake inhibitor. Norepinephrine, also known as noradrenalin, increases alertness and can effectively reduce ADHD fatigue [11]. An added benefit of atomoxetine is that it is a non-stimulant, meaning it does not increase dopamine and may have fewer, different side effects to stimulants such as methylphenidate. We discussed the effects of SNRIs on ADHD in more detail in our blog about antidepressants and ADHD.
In addition to medication, behavioural therapy (for example, cognitive behavioural therapy) can also be used to treat the symptoms of ADHD. This therapy can help improve organizational and time management skills, reduce impulsive behaviour, and improve relationships [6]. Managing these symptoms can reduce overwhelm and mental strain when navigating daily situations, improving fatigue in ADHD.
To summarize, fatigue is common in individuals with ADHD, mainly due to difficulties in navigating daily activities and ADHD medication. Treatments for ADHD fatigue include conventional treatments for ADHD, which need to be tailored to be sustainable and tolerable for individuals.